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Brain haemorrhage in babies may not indicate violent abuse

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7390.616/a (Published 22 March 2003) Cite this as: BMJ 2003;326:616

Vitamin K Deficiency Disease Misdiagnosed as SBS

Editor,

"Abused infants may have bleeding around the brain and in the eyes -
the hallmarks of SBS - but most also bear signs of the violence which
killed them, fractures, bruises, burns, malnutrition or neglect.”[1]

Regrettably this is the commonly held opinion of medical experts
giving evidence in cases of alleged child abuse.

It ignores the fact that fractures and bruises can result from
deficiencies of Vitamins C and/or K [2,3] and these deficiencies are not
necessarily the result of neglect.

Rutty et al; [4] have warned of the possibility of mistaking retinal
and subdural haemorrhages for child abuse but the lesson has not been
learned.

As regards fractures and bruises found on a child suspicion falls on
the carer if no explanation can be offered. It is absurd to demand an
explanation. How can you expect them to say:

“ You know doctor, there are several Vitamin K dependent proteins in
the body which require to be carboxylated by the enzyme gamma-glutamyl
carboxylase before they become functional. Without Vitamin K these
proteins, some of which control haemostasis and prevent bruising, and
others which control mineralization of bone and prevent fractures, cease
to be carboxylated and and hence bruises and fractures are likely to occur
anywhere[2].

My baby was given Vitamin K at birth but as you know doctor the
failure rate is about 0.25 per 100,000 [5].

That is my explanation doctor for the brusies and the fracture. I
hope you can understand it and don’t report me to the police or social
services, they may take my baby away and kill my dreams.”

The Royal Colleges should take steps to instruct their members to
exclude “natural causes” by appropriate clinical and newer laboratory
investigations [2] before accussing innocent carers of grievious bodily
harm, manslaughter or murder. Intracranial bleeding and retinal
haemorrhages with or without bruises and fractures should no longer be
claimed to be evidence of SBS.

Michael Innis

Reference

1.Squier W. Beyond reasonable doubt Guardian March 13 2008.

2.Clemetson CAB. Caffey Rvisited. A Commentary on th Origin of
“Shaken Baby Syndrome” Jour Amer Phys & Surg vol 11;2006: 20-21

3.Innis MD. Vitamin K Deficiency Disease Jour Ortho Mol Med March
2008

4.Rutty GN, Smith M, Malia RG. Late Form Hemorrhagic Disease of the
Newborn. A Fatal Case Report with Illustrations of Investigations Which
May Assist Avoiding the Mistaken Diagnosis of Child Abuse. Am J Forensic
Med Path 1999;20(1):48-51

5.von Kries R. Vitamin K prophylaxis – A usefull public health
measure? Paediatr Perinat Epidemiol 1992;6:7-13.

Competing interests:
I have given Expert evidence in cases of SBS in the UK,USA and AUSTRALIA.

Competing interests: No competing interests

28 September 2008
Michael D Innis
Director Medisets International
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